Whooping cough or pertussis is a highly communicable, vaccine-preventable bacterial infection of the respiratory system that typically affects children. The CDC reported that of the more than 13,400 cases reported in 2018, there were 10 deaths from pertussis. According to a recent Upper Michigan Source report, whooping cough is circulating in Upper Michigan (UP). And it’s likely that UP is not alone in its plight. Health officials say it is even easier for whooping cough to circulate as schools reopen and recommend that adults and children have their immunization status checked. With proper documentation, physicians can rely on outsourced coding and medical billing services to report pertussis diagnosis and treatment.
Whooping cough is caused by a bacterium called Bordetella pertussis. The toxins released by the bacteria damage the cilia that line part of the upper respiratory system and make the airways swell. The condition is highly contagious and spread by coughing or sneezing, or by spending a lot of time near the affected person. Babies usually get the infection from adults or siblings who are not even aware that they have the disease.
The most common symptom of the condition arefits of many, rapid coughs followed by a high-pitched “whoop” sound. The condition usually starts with symptoms that resemble a common cold. Early signs last for about one to two weeks and include runny nose, red watery eyes, sneezing, nasal congestion, low-grade fever, mild, occasional dry cough, and apnea or a pause in breathing pattern (in babies)
The second stage, which may last from one to 10 weeks, is characterized by uncontrolled and prolonged coughing fits, followed by a high-pitched “whoop”. Attacks occur more often at night. Other symptoms include accumulation of thick mucus, vomiting or choking, red or blue face, and fatigue.
The third stage, which is the convalescent stage, can last for weeks or months. It is characterized by a chronic cough with fewer sudden episodes.
The strenuous coughing can cause complications such as an abdominal hernia, broken blood vessels affecting the skin or eyes, and fractured or bruised ribs. Whooping cough complications in children include apnea, brain damage, dehydration, ear infections, pneumonia, and seizures.
Diagnosis and Treatment
Physicians can diagnose whooping cough by evaluating the person’s medical history and current symptoms. However, as whooping cough in adults is not usually accompanied by severe symptoms, lab tests may be needed to confirm the diagnosis. Lab tests ordered would commonly include a nasal or throat swab, which involve collecting a specimen of secretions (for e.g., mucus through the nose) to test for B. pertussis bacteria.
Treatment would depend on the duration of the illness and severity of symptoms. Pertussis is generally treated with antibiotics such as azithromycin, clarithromycin and erythromycin. Early treatment is crucial to minimize the severity of symptoms and duration of the illness, and also to reduce the risks of people spreading the disease.
According to the American Lung Association, treatment after 3 weeks of illness is unlikely to help though the bacteria have gone from the body. Symptoms will persist since the bacteria have already done the damage.
Unlike ICD-9 which had a separate code for any associated pneumonia as a secondary diagnosis, ICD-10 has a combination code for whooping cough and pneumonia. The ICD-10 codes for whooping cough/pertussis are:
A37.90 Whooping cough, unspecified species without pneumonia
A37.0 Whooping cough due to Bordetella pertussis
A37.00 …… without pneumonia
A37.01 …… with pneumonia
A37.1 Whooping cough due to Bordetella parapertussis
A37.10 …… without pneumonia
A37.11 …… with pneumonia
A37.8 Whooping cough due to other Bordetella species
A37.80 …… without pneumonia
A37.81 …… with pneumonia
A37.9 Whooping cough, unspecified species
A37.90 …… without pneumonia
A37.91 …… with pneumonia
The CDC recommends vaccination as the best way to prevent whooping among infants, children, adolescents, and adults. Preventive antibiotics are also used to protect people who have been exposed and are at high risk of developing severe pertussis Infants and others at high risk for pertussis complications should be kept away from infected people.
The recommended pertussis vaccine for babies and children is DTaP. In addition to pertussis, this combination vaccine helps protect against diphtheria and tetanus. A booster called Tdap for preteens, teens, and adults contains protection against tetanus, diphtheria and pertussis. The recommended doses of these vaccines are as follows:
- five doses of DTaP to children 2 months through 6 years of age
- one dose of Tdap for those 11 years or older, with a preferred administration at 11 or 12 years of age
- Tdap for pregnant women during each pregnancy, with a preferred administration during the early part of gestational weeks 27 through 36
CPT Codes for Pertussis Vaccine
The current CPT codes related to these vaccines are as follows:
90696 Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use
90697 Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use
90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP-IPV/Hib), for intramuscular use
90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use
90701 Diphtheria, tetanus toxoids, and whole cell pertussis vaccine (DTP), for intramuscular use
90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use
90720 Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Hemophilus influenza B vaccine (DTP-Hib), for intramuscular use
90721 Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine (DTaP/Hib), for intramuscular use
90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intramuscular use
Despite the availability of a vaccination to prevent whooping cough, the number of confirmed cases each year in the United States is on the rise. In fact, CDC researchers analyzed lab samples from whooping cough patients between 2000 and 2013 and found that the vaccine used for whooping cough is less effective because the bacteria behind the disease has mutated (USA Today).
As clinicians face the challenges of treating and preventing pertussis, they can rely on an experienced medical billing and coding company for submitting claims on time and getting paid without delay.